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Table of Contents
Front Cover
Contents
Foreword
Acknowledgments
About the Authors
Overview
Abbreviations
Chapter 1 Introduction
Introduction
Conclusions
References
Chapter 2 Effective Coverage: A Framework Linking Coverage and Quality
Introduction
Coverage, quality, and effective coverage
Empirical applications
Expanding the work on effective coverage by using data collected in health facilities
Conclusions
Notes
References
Chapter 3 Quality of Care: A Framework for Measurement
Introduction
Theoretical framework for assessing quality of care
Measuring quality of care for research and policy
Conclusions
Notes
References
Chapter 4 Decomposing the Constraints to Quality of Care Using Data on Antenatal Care Consultations from Five Sub-Saharan African Countries
Introduction
Why antenatal care?
Data
Results
Conclusions
Annex 4A: Additional tables and figures
Annex 4B: Data
References
Chapter 5 Performance-Based Financing Improves Coverage of Reproductive, Maternal, and Child Health Interventions
Introduction
PBF, health system performance, and health worker effort in theory
Evidence of the impact of PBF on the quality and quantity of health service delivery in LMICs
Impact of PBF on health worker motivation and satisfaction in six countries
Results
PBF, quality of care, and idle capacity
Conclusions
Notes
References
Chapter 6 Policy Alternatives to Performance-Based Financing
Introduction
Systematic review and meta-analysis of demand- and supply-side financial incentives
Comparing the PBF and DFF approaches
PBF, DFF, and institutional deliveries
PBF, DFF, and baseline effort
Complementarities in the PBF and DFF approaches
Discussion and conclusions
Annex 6A: Additional tables
Notes
References.
Chapter 7 Performance-Based Financing as a Health System Reform and Cautionary Evidence on Performance Pay and Irrelevant Care
Introduction
Provision of nonindicated treatment in the context of financial incentives
PBF as a health system reform
Conclusion
Notes
References
Chapter 8 Conclusion and Operational Implications
Message 1: Recognize that sustainability is about more than just money
Message 2: Support the four facility financing tenets
Message 3: Understand PBF incentives in a broader health system context
Message 4: Explore opportunities of maturing technologies
Building a forward-looking research agenda
References
Boxes
Box O.1 In Focus: Action items for task teams working on health financing reform
Box 1.1 In Focus: A short history of performance-based financing and the related evaluation agenda
Box 3.1 In Focus: Identifying misuse of care: A case study of malaria treatment in Mali
Box 3.2 In Focus: Measuring quality of care and provider effort in antenatal and maternal care
Box 4.1 In Focus: Exploring the drivers of variation in the content of care
Box 4.2 In Focus: Does discrimination contribute to poor effort?
Box 5.1 In Focus: A middle-income country's experience with performance-based financing: The case of Argentina and Plan Nacer and Programa Sumar
Box 5.2 In Focus: Theoretical underpinnings of health worker motivation and paying for performance
Box 5.3 In Focus: Measurement of worker motivation and satisfaction
Box 5.4 In Focus: Heterogeneous effects of performance-based financing on motivation and satisfaction: An example from Nigeria
Box 6.1 In Focus: Kyrgyz Republic PBF pilot
Box 6.2 In Focus: Demand-side interventions and incentives for increasing preventive screening for noncommunicable diseases in Armenia.
Box 6.3 In Focus: Systematic review search results
Box 6.4 In Focus: Mean effect size computation and subgroup analysis
Box 6.5 In Focus: Effect size heterogeneity
Box 6.6 In Focus: Combining supply- and demand-side incentives
Box 6.7 In Focus: PBF and equity
Box 6.8 In Focus: How do impacts depend on the baseline outcome values? Results from the meta-analysis
Box 8.1 In Focus: Combining technological innovations to facilitate strategic purchasing
Figures
Figure O.1 Effective coverage contours for antenatal care
Figure O.2 Lay of the land in centralized health systems in low-income countries
Figure O.3 Availability of drugs and consumables, equipment, and other supplies for providing antenatal care
Figure O.4 Know-can-do gaps in the provision of antenatal care
Figure O.5 Provision of unnecessary care in antenatal care provision in five Sub-Saharan African countries
Figure O.6 Impacts of performance-based financing on facility physical capacity in Cameroon and Nigeria
Figure O.7 Impacts of performance-based financing on idle capacity-or the know-can-do gap-in Cameroon and Nigeria
Figure O.8 Comparison of the pooled impact of performance-based and unconditional facility financing in five Sub-Saharan African countries (Cameroon, Nigeria, Rwanda, Zambia, and Zimbabwe)
Figure O.9 Impacts of PBF, vouchers, and conditional cash transfers on the utilization of maternal and child health services: Results from a meta-analysis
Figure 1.1 Lay of the land in centralized health systems
Figure 1.2 Lay of the land in health systems with the addition of demand- and supply-side incentives
Figure 2.1 Utilization, coverage, and effective coverage
Figure 2.2 Coverage, quality, effective coverage, and the care cascade
Figure 2.3 Effective coverage tree and its decomposition.
Figure 2.4 Effective coverage and its decomposition as the product of coverage and quality
Figure 2.5 Effective coverage contours and isocurves
Figure 2.6 Effective coverage and its decomposition: Antenatal care and pneumonia
Figure 2.7 Effective coverage contours for antenatal care
Figure 2.8 Effective coverage contours for hypertension treatment
Figure 2.9 Effective coverage contours for tuberculosis treatment
Figure 2.10 Effective coverage contours for HIV/AIDS treatment in Mozambique, by wealth quintile, 2015
Figure 2.11 Effective coverage contours for child malaria and diarrhea treatment
Figure 2.12 Effective coverage contours for various medical conditions
Figure 2.13 Potential data sources for measuring effective coverage
Figure 3.1 Prescriptions for antimalarials in the malaria case study
Figure 4.1 Effective antenatal care coverage in five Sub-Saharan African countries
Figure 4.2 Availability of drugs and consumables, equipment, and other supplies for providing antenatal care
Figure 4.3 Performance in patient-provider interactions during antenatal care
Figure B4.1.1 Variation in content of care in patient-provider interactions in antenatal care
Figure 4.4 Know-can-do gaps in the provision of antenatal care
Figure 4.5 Overuse in antenatal care provision in five Sub-Saharan African countries
Figure 4.6 Correlation between idle capacity and provider type
Figure B4.2.1 Inequality in the provision of ANC and effective ANC in the Democratic Republic of Congo
Figure 4A.1 Know-can-do gaps in the performance of antenatal care in Cameroon
Figure 4A.2 Know-can-do gaps in the performance of antenatal care in the Central African Republic
Figure 4A.3 Know-can-do gaps in the performance of antenatal care in the Democratic Republic of Congo.
Figure 4A.4 Know-can-do gaps in the performance of antenatal care in Nigeria
Figure 4A.5 Know-can-do gaps in the performance of antenatal care in the Republic of Congo
Figure 5.1 Key factors of performance-based financing that influence population health: An illustration
Figure 5.2 Impacts of performance-based financing on facility physical capacity in Cameroon and Nigeria
Figure 5.3 Impact of PBF on health worker motivation: Treatment effect (%), PBF vs. control
Figure 5.4 Impact of PBF on health worker satisfaction: Treatment effect (%), PBF vs. control
Figure 5.5 Impact of PBF on health worker well-being: Treatment effect (%), PBF vs. control
Figure B5.4.1 Impact of PBF on health worker motivation: Heterogeneity in treatment effects (%), by cadre, PBF vs. control
Figure 5.6 Impacts of performance-based financing on idle capacity-or the know-can-do gap-in Cameroon and Nigeria
Figure 6.1 Typology and theory of change of included financial incentive interventions
Figure B6.3.1 Search and data extraction results across all financial incentive intervention types
Figure B6.3.2 Programs per outcome, by financial incentive intervention type
Figure 6.2 Mean effect sizes for all incentive interventions combined
Figure 6.3 Mean effect sizes, by intervention type
Figure B6.6.1 Difference in mean effect size between schemes combining supply- and demand-side interventions and schemes intervening only on the supply or demand side
Figure 6.4 Comparison of the pooled impact of performance-based and unconditional facility financing in five Sub-Saharan African countries (Cameroon, Nigeria, Rwanda, Zambia, and Zimbabwe)
Figure 6.5 Impacts of PBF relative to DFF on idle capacity in antenatal care consultations in Cameroon and Nigeria
Figure B6.7.1 Patient socioeconomic status, PBF, DFF, and know-can-do gaps in Nigeria.
Figure B6.7.2 Patient socioeconomic status, PBF, DFF, and know-can-do gaps in Cameroon.
Contents
Foreword
Acknowledgments
About the Authors
Overview
Abbreviations
Chapter 1 Introduction
Introduction
Conclusions
References
Chapter 2 Effective Coverage: A Framework Linking Coverage and Quality
Introduction
Coverage, quality, and effective coverage
Empirical applications
Expanding the work on effective coverage by using data collected in health facilities
Conclusions
Notes
References
Chapter 3 Quality of Care: A Framework for Measurement
Introduction
Theoretical framework for assessing quality of care
Measuring quality of care for research and policy
Conclusions
Notes
References
Chapter 4 Decomposing the Constraints to Quality of Care Using Data on Antenatal Care Consultations from Five Sub-Saharan African Countries
Introduction
Why antenatal care?
Data
Results
Conclusions
Annex 4A: Additional tables and figures
Annex 4B: Data
References
Chapter 5 Performance-Based Financing Improves Coverage of Reproductive, Maternal, and Child Health Interventions
Introduction
PBF, health system performance, and health worker effort in theory
Evidence of the impact of PBF on the quality and quantity of health service delivery in LMICs
Impact of PBF on health worker motivation and satisfaction in six countries
Results
PBF, quality of care, and idle capacity
Conclusions
Notes
References
Chapter 6 Policy Alternatives to Performance-Based Financing
Introduction
Systematic review and meta-analysis of demand- and supply-side financial incentives
Comparing the PBF and DFF approaches
PBF, DFF, and institutional deliveries
PBF, DFF, and baseline effort
Complementarities in the PBF and DFF approaches
Discussion and conclusions
Annex 6A: Additional tables
Notes
References.
Chapter 7 Performance-Based Financing as a Health System Reform and Cautionary Evidence on Performance Pay and Irrelevant Care
Introduction
Provision of nonindicated treatment in the context of financial incentives
PBF as a health system reform
Conclusion
Notes
References
Chapter 8 Conclusion and Operational Implications
Message 1: Recognize that sustainability is about more than just money
Message 2: Support the four facility financing tenets
Message 3: Understand PBF incentives in a broader health system context
Message 4: Explore opportunities of maturing technologies
Building a forward-looking research agenda
References
Boxes
Box O.1 In Focus: Action items for task teams working on health financing reform
Box 1.1 In Focus: A short history of performance-based financing and the related evaluation agenda
Box 3.1 In Focus: Identifying misuse of care: A case study of malaria treatment in Mali
Box 3.2 In Focus: Measuring quality of care and provider effort in antenatal and maternal care
Box 4.1 In Focus: Exploring the drivers of variation in the content of care
Box 4.2 In Focus: Does discrimination contribute to poor effort?
Box 5.1 In Focus: A middle-income country's experience with performance-based financing: The case of Argentina and Plan Nacer and Programa Sumar
Box 5.2 In Focus: Theoretical underpinnings of health worker motivation and paying for performance
Box 5.3 In Focus: Measurement of worker motivation and satisfaction
Box 5.4 In Focus: Heterogeneous effects of performance-based financing on motivation and satisfaction: An example from Nigeria
Box 6.1 In Focus: Kyrgyz Republic PBF pilot
Box 6.2 In Focus: Demand-side interventions and incentives for increasing preventive screening for noncommunicable diseases in Armenia.
Box 6.3 In Focus: Systematic review search results
Box 6.4 In Focus: Mean effect size computation and subgroup analysis
Box 6.5 In Focus: Effect size heterogeneity
Box 6.6 In Focus: Combining supply- and demand-side incentives
Box 6.7 In Focus: PBF and equity
Box 6.8 In Focus: How do impacts depend on the baseline outcome values? Results from the meta-analysis
Box 8.1 In Focus: Combining technological innovations to facilitate strategic purchasing
Figures
Figure O.1 Effective coverage contours for antenatal care
Figure O.2 Lay of the land in centralized health systems in low-income countries
Figure O.3 Availability of drugs and consumables, equipment, and other supplies for providing antenatal care
Figure O.4 Know-can-do gaps in the provision of antenatal care
Figure O.5 Provision of unnecessary care in antenatal care provision in five Sub-Saharan African countries
Figure O.6 Impacts of performance-based financing on facility physical capacity in Cameroon and Nigeria
Figure O.7 Impacts of performance-based financing on idle capacity-or the know-can-do gap-in Cameroon and Nigeria
Figure O.8 Comparison of the pooled impact of performance-based and unconditional facility financing in five Sub-Saharan African countries (Cameroon, Nigeria, Rwanda, Zambia, and Zimbabwe)
Figure O.9 Impacts of PBF, vouchers, and conditional cash transfers on the utilization of maternal and child health services: Results from a meta-analysis
Figure 1.1 Lay of the land in centralized health systems
Figure 1.2 Lay of the land in health systems with the addition of demand- and supply-side incentives
Figure 2.1 Utilization, coverage, and effective coverage
Figure 2.2 Coverage, quality, effective coverage, and the care cascade
Figure 2.3 Effective coverage tree and its decomposition.
Figure 2.4 Effective coverage and its decomposition as the product of coverage and quality
Figure 2.5 Effective coverage contours and isocurves
Figure 2.6 Effective coverage and its decomposition: Antenatal care and pneumonia
Figure 2.7 Effective coverage contours for antenatal care
Figure 2.8 Effective coverage contours for hypertension treatment
Figure 2.9 Effective coverage contours for tuberculosis treatment
Figure 2.10 Effective coverage contours for HIV/AIDS treatment in Mozambique, by wealth quintile, 2015
Figure 2.11 Effective coverage contours for child malaria and diarrhea treatment
Figure 2.12 Effective coverage contours for various medical conditions
Figure 2.13 Potential data sources for measuring effective coverage
Figure 3.1 Prescriptions for antimalarials in the malaria case study
Figure 4.1 Effective antenatal care coverage in five Sub-Saharan African countries
Figure 4.2 Availability of drugs and consumables, equipment, and other supplies for providing antenatal care
Figure 4.3 Performance in patient-provider interactions during antenatal care
Figure B4.1.1 Variation in content of care in patient-provider interactions in antenatal care
Figure 4.4 Know-can-do gaps in the provision of antenatal care
Figure 4.5 Overuse in antenatal care provision in five Sub-Saharan African countries
Figure 4.6 Correlation between idle capacity and provider type
Figure B4.2.1 Inequality in the provision of ANC and effective ANC in the Democratic Republic of Congo
Figure 4A.1 Know-can-do gaps in the performance of antenatal care in Cameroon
Figure 4A.2 Know-can-do gaps in the performance of antenatal care in the Central African Republic
Figure 4A.3 Know-can-do gaps in the performance of antenatal care in the Democratic Republic of Congo.
Figure 4A.4 Know-can-do gaps in the performance of antenatal care in Nigeria
Figure 4A.5 Know-can-do gaps in the performance of antenatal care in the Republic of Congo
Figure 5.1 Key factors of performance-based financing that influence population health: An illustration
Figure 5.2 Impacts of performance-based financing on facility physical capacity in Cameroon and Nigeria
Figure 5.3 Impact of PBF on health worker motivation: Treatment effect (%), PBF vs. control
Figure 5.4 Impact of PBF on health worker satisfaction: Treatment effect (%), PBF vs. control
Figure 5.5 Impact of PBF on health worker well-being: Treatment effect (%), PBF vs. control
Figure B5.4.1 Impact of PBF on health worker motivation: Heterogeneity in treatment effects (%), by cadre, PBF vs. control
Figure 5.6 Impacts of performance-based financing on idle capacity-or the know-can-do gap-in Cameroon and Nigeria
Figure 6.1 Typology and theory of change of included financial incentive interventions
Figure B6.3.1 Search and data extraction results across all financial incentive intervention types
Figure B6.3.2 Programs per outcome, by financial incentive intervention type
Figure 6.2 Mean effect sizes for all incentive interventions combined
Figure 6.3 Mean effect sizes, by intervention type
Figure B6.6.1 Difference in mean effect size between schemes combining supply- and demand-side interventions and schemes intervening only on the supply or demand side
Figure 6.4 Comparison of the pooled impact of performance-based and unconditional facility financing in five Sub-Saharan African countries (Cameroon, Nigeria, Rwanda, Zambia, and Zimbabwe)
Figure 6.5 Impacts of PBF relative to DFF on idle capacity in antenatal care consultations in Cameroon and Nigeria
Figure B6.7.1 Patient socioeconomic status, PBF, DFF, and know-can-do gaps in Nigeria.
Figure B6.7.2 Patient socioeconomic status, PBF, DFF, and know-can-do gaps in Cameroon.